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Background Fingertip replantation has become a standard operation for well-experienced microsurgeons, but naturally there are some unsuccessful cases. Furthermore, younger surgeons need experience with this procedure, as replantations are often an emergency operation and experts may not be available to attend. Therefore, we reviewed our cases to determine the most effective procedure that can enable young surgeons to obtain a good outcome. Methods We retrospectively investigated 69 fingertip replantation cases treated between January 2006 and December 2014 at the Kyorin University Hospital. All operations were performed by several young surgeons who were instructed by one experienced surgeon (the principal author, T.S.). In this study, cases were divided into three groups according to vein graft usage. In group A, a long vein graft that reached the proximal phalanx was employed. In group B, a short vein graft that was almost as long as the arterial defect was employed. In group C, no vein graft was used. The differences in the survival rates of the fingertips between the groups were analyzed. Results The total fingertip survival rate was 93% (64 out of 69). All 42 (100%) fingertips in group A survived, 5 of 6 (83%) fingertips in group B survived, and 17 of 21 (81%) fingertips in group C survived. Conclusion Preferential use of a long vein graft could provide superior results and enable young surgeons to perform successful fingertip replantations, as it is a reliable and relatively an easy procedure compared with other techniques.

From October 1999 to July 2005, defects after total glossectomy with laryngectomy (TGL) for cancer of the tongue or middle pharynx were reconstructed with rectus abdominis myocutaneous (RAMC) flaps in nine patients. The skin flaps were designed larger in width than the original defect to create a funnel-shaped oropharynx and prevent stricture. Six patients had uneventful postoperative courses and began to eat perorally 8 to 15 days postoperatively. One patient suffered flap necrosis due to arterial thrombosis and two patients had leakage. Eventually, eight patients could eat soft foods or gruel, except one patient who had ingested food through a gastrostomy preoperatively. When TGL was performed without mandibulectomy, the blood supply for the remnant mucosa of the backside of the mandible is generally not good, for which the reconstruction with the overlapping deepithelialized flap and muscle is useful for prevention of the fistula formation. We considered that the RAMC flap is a good option for reconstruction after TGL.

A double vascular pedicled free jejunum was transferred in two patients with complete esophageal defect. When the stomach and colon, which are usually employed for esophageal reconstruction, cannot be used due to previous operations or for other reasons, the jejunum is the next alternative. However, pedicled jejunal transposition is limited in length and may not reach a suitable level over the lower cervical esophagus, even if the distal portion is supercharged. Under such circumstances, a long jejunal segment with two vascular pedicles can be transferred as a free flap and used to reconstruct the whole esophagus in one stage. The paper describes two cases and discusses the advantages of double vascular pedicled free jejunum transfer.

Microvascular free tissue transfer has gained world-wide acceptance as a means of reconstructing post-oncologic surgical defects in the head and neck region. Since 1977, the authors have introduced this reconstructive procedure to head and neck reconstruction after cancer ablation, and a total of 2372 free flaps were transferred in 2301 patients during a period of over 23 years. The most frequently used flap was the rectus abdominis flap (784 flaps: 33.1 percent), followed by the jejunum (644 flaps: 27.2 percent) and the forearm flap (384 flaps: 16.2 percent). In the reported series, total and partial flap necrosis accounted for 4.2 percent and 2.5 percent of cases, respectively. There was a significant statistical difference ( p < 0.05) in complete flap survival rate between immediate and secondary reconstruction cases. The authors believe that the above-mentioned three flaps have been a major part of the armamentarium for head and neck reconstruction because of a lower rate of flap necrosis, compared to other flaps.

An expanded latissimus dorsi flap (expanded LD flap) was transferred in two patients with severe post-burn neck contracture. Free flaps created using standard techniques are of limited size and sometimes cannot cover the defect after excision of scar tissue, particularly when a severe burn scar extends to the facial region. However, the authors found in their cases that the expanded LD flap could cover the whole anterior neck and face. The flap was sufficiently reduced in thickness so that revisional operations required for debulking were limited to the area around the pedicles. It is suggested that tissue expansion prior to free flap transfer is useful for enlargement of the flap survival area and thinning of the flap.